Advantages:

For a person in need of a liver transplant, there are advantages to a living-donor transplant.

You Can Have A Very Short Wait.

With more than 18,000 Americans now on waiting lists for liver transplants, and about one-quarter that number of cadaver livers available each year, the wait for a cadaver liver continues to grow longer.

While the length of time a person has to wait for a cadaver liver to become available depends on an individual's medical condition, blood type, and varies from center to center, a wait of one to two years or more is not uncommon. And some number of patients with liver disease die while waiting on the list for a suitable cadaver organ to become available.

Many patients with specific diseases -- such as patients with liver or bile duct tumors -- would benefit from proceeding with liver transplantation as quickly as possible. Patients with progressive diseases such as primary hyperoxaluria, familial amyloidosis, pulmonary hypertension, or hepatopulmonary syndrome would benefit from the earlier transplantation that may be possible with a living donor.

If an eligible living donor offers to give you part of a liver, and proves to be an acceptable match, the transplant operation could proceed in a matter of weeks.

You Can Receive The Transplant While in Relatively Good Health.

Unlike cadaver kidneys, which are allocated to patients based primarily on time on the waiting list, a major effort is being made to allocate cadaver livers on the basis of medical urgency. This generally means a person will have to become very ill to receive a cadaver liver. Already, about half of all available cadaver livers go to patients judged likely to die in a matter of days or weeks without a transplant. And a new allocation system recently approved by UNOS, set to go into effect later this year, will continuously reprioritize all but the most urgent patients based on their medical status. A person on the liver waiting list, who is not likely to receive a cadaver organ until his or her illness progresses, can seek to proceed with a living-donor transplant while still in relatively good health.

Recovery from transplant surgery, and a return to an active life, obviously is easier if a person's health has not seriously deteriorated.

You Can Arrange to Have the Transplant at Your Convenience

If you have a qualified living donor prepared to give you part of that person's liver, the two of you can work out a convenient date for surgery with your transplant center -- avoiding the months or years of uncertainty endured by persons who never know when (or if) they will receive a call telling them that a cadaveric liver has become available.

Medical Advantages

Not enough living donor liver transplants have been performed from one adult to another to establish the comparative medical advantages of a living liver donation transplant over a cadaveric transplant for the recipient.

Certainly, the surgery to transplant a portion of a liver is more complicated than transplanting a whole liver from a cadaver to a recipient. The operation typically involves taking the right lobe of the donor's liver (which generally accounts for a little more than half of the liver), and transplanting it into the recipient. The transplanted segment must be at least one percent of the recipient's body weight in order to provide an adequate amount of liver tissue for immediate function.

Because a living liver tranplant operation is well planned, the donor's liver can be carefully matched to the recipient. The recipient's medical condition also can be optimized prior to surgery. Another plus is that the time between the moment the transplanted portion of the liver stops functioning in one donor and begins functioning in the recipient is minimized, reducing damage to liver tissue.

The quality of the donated liver segment -- coming from a person in good health and with good liver function -- presumably would be superior to that of a cadaveric liver, which may well have been subjected to some degree of trauma.

The bottom line, of course, ultimately will be found in the organ survival rates. Because adult-to-adult living liver donation is such a recent phenomenon, meaningful comparative three-year and five-year survival rates are not yet available. UNOS says the latest statistics show a one-year organ survival rate for living donor livers of 73.2 percent compared to a one-year organ survival rate for cadaveric livers of 79.1 percent. But the Hume-Lee Transplant Center at the Medical College of Virginia, which says it is the most experienced adult-to-adult liver transplant program having performed more than 50 of these surgeries, says its one-year organ survival rate for living liver transplants performed in 1999-2000 is 81 percent.

What this suggests is that anyone thinking of a living donor liver transplant would be well advised to have it performed at one of the major centers that performs a high-volume of these liver transplants.

Disadvantages:

From the standpoint of the person in need of a liver transplant, the surgery involved in a living donor transplant is more complex than in a cadaver transplant.

The transplanted liver segment is smaller than a cadaver liver, possibly increasing the risk of dysfunction. Anatomical complexites may also lead to a higher complication rate.

Some patients may also be told they have specific medical problems that would prevent them from having a successful living donor transplant.

Issues that need to be considered by the donor are addressed in the section "What Should I Consider."

As with all information provided in this site, it is offered for educational purposes only, and it is not intended nor implied to be a substitute for professional medical advice. Always consult your own physician or healthcare provider with any questions you may have regarding a medical condition.